Analgesic Efficacy of Pfannenstiel Incision Infiltration with Ropivacaine 7.5 mg/mL for Caesarean Section.

Background. Pain after Caesarean delivery is partly related to Pfannenstiel incision, which can be infiltrated with local anaesthetic solutions. Methods. A double- blind randomized control trial was designed to assess the analgesic efficacy of 7.5 mg/mL ropivacaine solution compared to control group, in two groups of one hundred and forty four parturients for each group, who underwent Caesarean section under spinal anaesthesia: group R (ropivacaine group) and group C (control group). All parturients also received spinal sufentanil (2.5 mug). Results. Ropivacaine infiltration in the Pfannenstiel incision for Caesarean delivery before wound closure leads to a reduction of 30% in the overall consumption of analgesics (348 550 mg for group R versus 504 426 mg for group C with P < .05), especially opioids in the first 24 hours, but also significantly increases the time interval until the first request for an analgesic (4 h 20 min +/- 2 h 26 for group R versus 2 h 42 +/- 1 h 30 for group C). The P values for the two groups were: P < .0001 for paracetamol, P < .0001 for ketoprofen and P for nalbuphine which was the most significant. There is no significant difference in the threshold of VAS in the two series. Conclusion. This technique can contribute towards a programme of early rehabilitation in sectioned mothers, with earlier discharge from the post-labour suite.

Traitement medical du mal de Pott: a propos des 18 cas

Introduction: la tuberculose vertebrale est de loin la localisation osteo-articulaire la plus frequente ; son traitement est de moins en moins chirurgical; la duree et les modalites du traitement medical restent cependant sujettes a discussion.Le but de ce travail est de proposer une attitude therapeutique standardisee pour le mal de Pott. Patients et methodes : Les acteurs rapportent une etude retrospective de 18 cas de mal de pott. Resultats : L'age moyen etait de 51 ans .Tous les malades ont beneficie d'un traitement medical ; aucune indication chirurgical n'a ete portee.l'imagerie par resonance magnetique et la biopsie sous scanner ont permis d'eviter les abords churirgicaux a visee diagnostic.La chimiotherapie consistait en une phase d'attaque comprenant quatre antituberculeux d'une duree moyenne de 5 mois ; suivi d'une phase d'entretien associant uniquement deux antituberculeux majeurs en prise quotidienne et d'une duree moyenne de 11 mois .Huit patients ont eu une immobilisation rachidienne. Apres un recul moyen de 36 mois l'evolution clinique et anatomique etait favorable pour tous les maladies. Aucune aggravation des troubles neurologiques n'a ete notee. Conclusion: traitement medical antituberculeux bien conduit est toujours efficace surtout si le diagnostic est assez precoce et permet ainsi d'eviter le recours a la chirurgie assez laborieuse et dont les resultats ne sont pas encourangeants

Antiphospholipid antibodies and preeclampsia: a case-control study.

OBJECTIVE: To assess the association between the occurrence first of preeclampsia and antiphospholipid antibodies. METHODS: We conducted a prospective case-control study of 180 pregnant women with their first incidents of preeclampsia and no histories of thrombosis or systemic autoimmune diseases. Preeclampsia (n = 180) was defined as blood pressure (BP) at least 140/90 mmHg after 20 weeks' gestation and proteinuria at least 0.3 g per 24 hours. Two control subjects were matched to each case (n = 360). They were pregnant women without hypertension or proteinuria and without histories of thrombosis or systemic autoimmune disease. Lupus anticoagulant (activated partial thromboplastin time, diluted thromboplastin time, platelet neutralization procedure) and anticardiolipin antibodies (immunoenzymatic assays) were assessed in both groups, and the coagulation state (levels of thrombin-antithrombin III complexes, fragments 1 + 2 of prothrombin) was also evaluated. The analysis design was a sequential plan with 5% type I error and 95% power. RESULTS: There was no association between antiphospholipid antibodies and preeclampsia. The odds ratio for the association was 0.95 (95% confidence interval 0.45, 2.61). Antiphospholipid antibodies were detected in eight of 180 preeclamptic women and in 19 of 360 controls. In contrast, there was a clear, confirmed activation of coagulation during preeclampsia. CONCLUSION: Despite evidence of a prothrombotic state during preeclampsia, it is unlikely that antiphospholipid antibodies (lupus anticoagulant and anticardiolipin antibodies) represent risk factors for preeclampsia among women with no previous preeclampsia and no histories of thrombosis or systemic autoimmune disease.

[Late results of Mac Murray's osteotomy]. / Les résultats éloignés de l'ostéotomie de Mac Murray.

From a total of 817 cases, 133 cases were reviewed where a Mc Murray osteotomy had been carried out more than 10 years previously. Operative results were favourable, but the authors stress the very precise indications for this procedure. Deterioration occurred in one case where the indication appeared dubious. With the development of arthroplasty, this has replaced osteotomy in cases where a doubt exists. Mc Murray osteotomy remains indicated in conservative surgery and in particular the results of arthroplasty of the hip indicate that this very interesting alternative should not be forgotten.